Where you live drives wait for transplant

Associated Press

WASHINGTON

Doctors dropped another bomb soon after telling Matthew Rosiello it was time for a liver transplant: The 21-year-old isn’t likely to get one any time soon in his home state of New York. Consider traveling to Ohio, they advised, where the wait’s a lot shorter.

Where you live plays a big role in how sick you are, and how long you wait, before getting a scarce liver transplant — if you survive long enough. Now the network that runs the U.S. organ transplant system is exploring steps to ease some of the disparities. Critics who want more nationwide sharing of donated livers fear any changes won’t help enough.

The nation has a severe shortage of donated livers. More than 16,000 people are awaiting a liver transplant, and just 6,300 a year get one. More than 1,400 others die waiting each year.

Since 2002, the sickest patients have been ranked atop waiting lists to receive a liver from a deceased donor. They’re given a so-called MELD score, based on laboratory tests, that predicts their risk of death. Rising scores move them up on the waiting list. The change by all accounts has greatly improved the system, which once was based instead on time spent waiting.

Here’s the lingering trouble: Patients with liver failure and would-be donors are not distributed evenly around the country. And the nation is divided into 11 transplant regions that have wide variations in patients and available organs, between regions and within them.

A donated liver is offered first to the sickest patients in the local transplant center, and if there’s no good match, then to the sickest patients throughout that transplant region. If there’s still no good match, the liver can go to someone who’s not as sick — rather than to someone sicker in the next transplant region.